Pope's words his own "living will"?

ROME — A year ago, Pope John Paul II turned Catholic teaching on its head when he declared that it was a moral obligation to provide food and water indefinitely, even to patients in a vegetative state with no hope of recovery.

"The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act," he said at an international conference last March.

Now, with the ailing, 84-year-old pontiff is being nourished by a feeding tube, and with the recent spotlight on such issues in light of Terri Schiavo's case, those words are being re-read. John Paul's words may indicate what he wants for his own care and how the Vatican will go about making such decisions.

"The closest thing we have to a living will for John Paul is this document he issued a year ago," said the Rev. Thomas Reese, a Vatican expert and editor of America, a Catholic weekly. "Clearly, it's going to be very difficult to disconnect any fluids or hydration from him because that can be interpreted as his will about how he would want to be treated."

There are no Vatican rules or traditions for who makes medical decisions for a pontiff. And many say that the prospect of a living, incapacitated pope is a medical dilemma with potentially disastrous implications for a church that is an absolute monarchy in which all power is vested in him. What would happen, for instance, if John Paul should become mentally unfit? What if he is attached to a respirator and can't be taken off? Who could — or would — disconnect the pope?

"This is a totally new situation," said the Rev. Robert Taft, professor emeritus at the Pontifical Oriental Institute in Rome. "In the old days, people got sick and in a month they were dead. Now people get sick and they're plugged into a wall and they can live for years."

Questions about how such decisions would be made loom larger with reports that the pope is getting nourishment through a feeding tube attached to his nose because he has had difficulty swallowing.

The pope, who has advanced Parkinson's disease, underwent a Feb. 24 tracheotomy to help him breathe and still has a tube inserted in his windpipe.

In the pope's speech, delivered March 20 of last year to doctors, ethicists and scientists from 40 countries, he argued that a sick person, even in a vegetative state, "still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.) and to the prevention of complications related to his confinement to bed."

The speech stunned many Catholic theologians, who said it was a break from 400 years of Catholic moral tradition that held that a medical procedure was obligatory only if it offered hope of checking or curing a disease.

"We've had a long-standing tradition that you can't kill, but you can remove that which prolongs your dying," said the Rev. James Keenan, a professor of theological ethics at Boston College.

"The big question is, what will the Vatican take off the list of extraordinary means next? What's to say you can't refuse a ventilator or a resuscitation? And how hard will it be to die in a Catholic facility — and in particular, how hard will it be to die if you're the pontiff?"

Based in large part on that speech, the Vatican and several senior churchmen took an unusually strong stance in the case of the brain-damaged Schiavo, publicly supporting her parents' pleas to the courts.

In a stinging front-page editorial, the Vatican newspaper L'Osservatore Romano criticized a U.S. federal judge's refusal to order the reinsertion of Schiavo's feeding tube last week. The editorial said that decision amounted to capital punishment for someone who had committed no crime.

Keenan said that response overshadowed more-nuanced responses like that of Schiavo's own bishop, Robert Lynch of St. Petersburg, Fla., who refused her parents' request to intervene in the case.

"The pope says lots of things," Keenan said, "but then you have to wait and find out whether the church is going to promote and promulgate that as teaching."

And he noted that the Catholic Health Association, which includes most U.S. Catholic hospitals, has not changed its policies on end-of-life decisions, which continue to be based on evaluating the benefits and burdens of a treatment for a particular patient.

But the million-dollar questions are how John Paul's speech may be applied to difficult decisions about his own medical care and whether it could be interpreted at some point to mean that an incapacitated pope could be on life support indefinitely.

Taft, of the Pontifical Oriental Institute, said he is not worried it will come to that.

"I take it seriously that the pope has said that he commends himself to God, and when it's time for God to take him, he will let go," Taft said.

But John Paris, a moral theologian at Boston College, said he is not so sure.

"The right-to-life types want to keep everyone going forever," he said. "Seems that Lenin's mausoleum will be the model for the future."

Information from The Associated Press was included in this article.